Terry Venables School of Soccer

MEDICAL CONSENT FORM

Camper Information

Name 

Address

Parent / Guardian

Parent / Guardian
Home Phone      Business Phone

MEDICAL HISTORY

Past or Present Condition 

Allergies 

Medications

Medical Insurance

I hereby state that my child is in good normal health, and has my permission to participate in all camp activities. In addition, I authorize the Terry Venables School of Soccer staff to act on behalf in securing medical treatment in the event of illness or injury. A registratin requires that a parent/guardian sign below to agree that in case of an accident while attending a Terry Venables School of Soccer camp, they release Terry Venables School of Soccer, the Ownership, the Coaches, the Director of Coaching and Administrator from any and all liability. Each camper is required to carry personal medical insurance coverage.

Signed                                                                                    Date                                       

Print Name of Person Signing